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Increased ambulatory utilization in IPA plans among children receiving hyposensitization therapy
P G Szilagyi1, K J Roghmann, H R Foye
1Pediatric Ambulatory Services, Strong Memorial Hospital, Rochester, NY 14642.
Insights
Children with chronic conditions in managed care plans showed improved well-child visits after enrolling in an Independent Practice Association (IPA). This suggests better primary care access for these pediatric patients.
Area of Science:
- Pediatric Health
- Health Services Research
- Managed Care
Background:
- Concerns exist regarding suboptimal care for children with chronic conditions within managed care systems.
- Children with chronic conditions may face barriers to accessing necessary healthcare services.
Purpose of the Study:
- To investigate the association between enrollment in an Independent Practice Association (IPA) plan and ambulatory service utilization.
- To assess changes in healthcare access for children with mild chronic conditions (allergic diseases requiring hyposensitization) after switching to IPA coverage.
Main Methods:
- Retrospective chart review of 102 children enrolled in an IPA plan, comparing utilization one year before and after enrollment.
- Comparison with 57 age-matched control patients covered by Blue Cross (non-IPA).
- Analysis focused on well-child care (WCC), acute care visits, and specialist referrals.
Main Results:
- Children receiving hyposensitization therapy were more likely to enroll in an IPA.
- Pre-IPA enrollment, patients had significantly fewer WCC visits compared to controls.
- Post-IPA enrollment, a significant increase in WCC and acute care visits was observed, with no change in specialist referrals.
Conclusions:
- Enrollment in an IPA plan was associated with improved utilization of primary care services, including well-child care and acute visits, for children with mild chronic conditions.
- This study found no evidence of reduced access to ambulatory services; instead, it suggests enhanced primary care utilization in this specific managed care setting.
Abstract:
There is concern that children with chronic conditions are less likely to be enrolled in managed care systems and that they may not receive optimal care. We studied the relationship between enrollment in an Independent Practice Association (IPA) plan and utilization of ambulatory services among children in a suburban pediatric practice with one mild chronic condition--those receiving hyposensitization therapy for allergic diseases. Ambulatory utilization by IPA patients (N = 102) was determined by medical chart review for one year before and one year after each patient switched from Blue Cross to IPA coverage. Blue Cross hyposensitization patients (N = 57) matched for age served as controls. Patients receiving hyposensitization were more likely to have enrolled in an IPA than those not receiving hyposensitization (70% vs 45%, p < .001). Before enrollment pre-IPA patients had 41% fewer well-child care (WCC) visits than Blue Cross patients (p < .01); both underutilized WCC visits according to established guidelines. Controlling for age and baseline utilization, we found a significant increase in WCC and acute care visits after IPA enrollment (p < .05), but no change in hyposensitization visits or referrals. In this setting, there was no evidence for reduced access to ambulatory services but rather evidence for improved utilization of primary care.